CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 4, July/August 2014
e12
AFRICA
definite anaesthesia protocol. Anaesthetic goals in paediatric
patients with congenital heart disease include preservation of
haemodynamic stability with minimal depression of contractility,
avoiding arrhythmias, and the maintenance of homeostasis
between systemic and pulmonary circulations.
One of the routes used for induction in cardiac paediatric
patients is via inhalational agents. Although induction with
volatile anaesthetics in cardiac paediatric patients can have
potentiallydeleterious effects due tocompromisedhaemodynamic
stability, of these agents, sevoflurane appears to have less cardiac
depressant effects than other halogenated agents.
7
Courreges
et al.
reported that the anaesthetic management for a Cohen
procedure in a girl with Edwards syndrome,
8
and longer duration
of induction (8 min) with sevoflurane was linked to a change in
the ventilation/perfusion ratio caused by the cardiac disease.
In our patient, due to the problem of existing vascular access,
we chose sevoflurane and performed an uneventful and regular
duration of induction. Although pancuronium may be preferred
for neuromuscular blockade of patients undergoing cardiac
surgeries, it has a slow onset and prolonged duration of action,
and is eliminated mainly by renal excretion. Instead we preferred
rocuronium, a non-depolarising NMB agent structurally related
to pancuronium, based on its rapid onset, intermediate duration
of action, and non-histamine release property with a metabolism
rate of less than 1%, taken up by the liver and excreted into
bile.
9
We also preferred fentanyl because it improves the protein
metabolism of premature neonates enduring the stress of a PDA
and is considered to be the first drug choice in children with
pulmonary hypertension.
10
In the early postoperative course of congenital cardiac
surgery, more than 20% of patients exhibit low cardiac output
syndrome (LCOS), characterised by poor systemic perfusion and
high vasoactive drug requirements.
11
We transferred our patient
with a 5-µg/kg/min dopamine infusion to the neonatal ICU.
Conclusion
Neonates with trisomy 18 are an uncommon subgroup of cardiac
surgery patients with a short life expectancy. Our knowledge
of the proper anaesthetic technique for children undergoing
palliative or corrective surgery is limited. Further case reports
will increase our experience in peri-operative management of
children with trisomy 18.
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